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Safety and Efficacy of Exposure-based Risk Reduction Through Family Therapy for Co-occurring Substance Use Problems and Posttraumatic Stress Disorder Symptoms Among Adolescents: A Randomized Clinical Trial

NCJ Number
Jama Psychiatry Volume: 77 Issue: 6 Dated: 2020 Pages: 574-586
Date Published
13 pages

In this article, the authors seek to answer the question of whether exposure-based risk reduction through family therapy is a safe and effective treatment compared with treatment-as-usual for adolescents who have co-occurring substance use problems and post-traumatic stress disorder symptoms; they present their key research points, methodology, results, and conclusions.


No empirically supported treatments have been evaluated to address co-occurring substance use problems (SUP) and post-traumatic stress disorder (PTSD) symptoms among adolescents in an integrative fashion. This lack is partially owing to untested clinical lore suggesting that delivery of exposure-based PTSD treatments to youth with SUP might be iatrogenic. For their research, the authors’ objective was to determine whether an exposure-based, integrative intervention for adolescents with SUP and PTSD symptoms—risk reduction through family therapy (RRFT)—resulted in improved outcomes relative to a treatment-as-usual (TAU) control condition consisting primarily of trauma-focused cognitive behavioral therapy. This randomized clinical trial enrolled 124 participants who were recruited from November 1, 2012, through January 30, 2017. The authors enrolled adolescents, aged 13 to 18 years, who engaged in nontobacco substance use at least once during the past 90 days, experienced at least one interpersonal traumatic event, and reported five or more PTSD symptoms, and participants were randomized to receive either RRFT or TAU. Primary outcomes focused on number of non-tobacco substance-using days measured with the timeline follow-back method and PTSD symptom severity using the University of California, Los Angeles (UCLA) PTSD Reaction Index for DSM-IV completed by adolescents and caregivers. Secondary outcomes focused on marijuana, alcohol, and polysubstance use and PTSD criterion standard (re-experiencing, avoidance, and hyperarousal) symptom severity. The authors conclude that RRFT and TAU demonstrated within-group improvements in SUP and PTSD symptoms, with greater improvement for substance use and PTSD avoidance and hyperarousal symptoms among adolescents randomized to RRFT compared with TAU. No evidence of the worsening of SUP was observed in either condition. These results suggest that this exposure-based treatment is safe, feasibly delivered by community-based clinicians, and offers an effective approach to inform clinical practice. Publisher Abstract Provided

Date Published: January 1, 2020